Sec. 105. Requiring coverage under Medicare PDPs and MA–PD plans, without the imposition of cost sharing or utilization management requirements, of drugs intended to treat COVID–19 during certain emergencies

639 words·~3 min read·/bill/116/hr/6674/ih/section-105

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Section 1860D–4(b)(3) of the Social Security Act ( 42 U.S.C. 1395w–104(b)(3) ) is amended by adding at the end the following new subparagraph: Notwithstanding any other provision of law, a PDP sponsor offering a prescription drug plan shall, with respect to a plan year, any portion of which occurs during the period described in clause (ii), be required to— include in any formulary— all covered part D drugs with a medically accepted indication (as defined in section 1860D–2(e)(4)) to treat COVID–19 that are marketed in the United States; and all drugs authorized under section 564 or 564A of the Federal Food, Drug, and Cosmetic Act to treat COVID–19; and not impose any prior authorization or other utilization management requirement with respect to such drugs described in item

(aa)or

(bb)of subclause

(I)(other than such a requirement that limits the quantity of drugs due to safety). For purposes of clause (i), the period described in this clause is the period during which there exists the public health emergency declared by the Secretary pursuant to section 319 of the Public Health Service Act on January 31, 2020, entitled Determination that a Public Health Emergency Exists Nationwide as the Result of the 2019 Novel Coronavirus (including any renewal of such declaration pursuant to such section). . Section 1860D–2 of the Social Security Act ( 42 U.S.C. 1395w–102 ) is amended— in subsection (b)— in paragraph (1)(A), by striking The coverage and inserting Subject to paragraph (8), the coverage ; in paragraph (2)— in subparagraph (A), by inserting after Subject to subparagraphs

(C)and

(D)the following: and paragraph

(8); in subparagraph (C)(i), by striking paragraph

(4)and inserting paragraphs

(4)and

(8); and in subparagraph (D)(i), by striking paragraph

(4)and inserting paragraphs

(4)and

(8); in paragraph (4)(A)(i), by striking The coverage and inserting Subject to paragraph (8), the coverage ; and by adding at the end the following new paragraph: The coverage does not impose any deductible, copayment, coinsurance, or other cost-sharing requirement for drugs described in section 1860D–4(b)(3)(I)(i)(I) with respect to a plan year, any portion of which occurs during the period during which there exists the public health emergency declared by the Secretary pursuant to section 319 of the Public Health Service Act on January 31, 2020, entitled Determination that a Public Health Emergency Exists Nationwide as the Result of the 2019 Novel Coronavirus (including any renewal of such declaration pursuant to such section). ; and in subsection (c), by adding at the end the following new paragraph: The coverage is in accordance with subsection (b)(8). . Section 1860D–14(a) of the Social Security Act ( 42 U.S.C. 1395w–114(a) ) is amended— in paragraph (1)— in subparagraph (D)— in clause (ii), by striking In the case of and inserting Subject to subparagraph (F), in the case of ; and in clause (iii), by striking In the case of and inserting Subject to subparagraph (F), in the case of ; and by adding at the end the following new subparagraph: Coverage that is in accordance with section 1860D–2(b)(8). ; and in paragraph (2)— in subparagraph (B), by striking A reduction and inserting Subject to subparagraph (F), a reduction ; in subparagraph (D), by striking The substitution and inserting Subject to subparagraph (F), the substitution ; in subparagraph (E), by inserting after Subject to the following: subparagraph

(F)and ; and by adding at the end the following new subparagraph: Coverage that is in accordance with section 1860D–2(b)(8). . Section 1860D–14(a)(3)(C)(i) of the Social Security Act ( 42 U.S.C. 1395w–114(a)(3)(C)(i) ) is amended by inserting and any amounts received from a State as unemployment benefits after furnished in kind . Notwithstanding any other provision of law, the Secretary of Health and Human Services may implement the amendments made by this section by program instruction or otherwise.

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42 USC 1395w–104(b)(3)
42 USC 1395w–102
42 USC 1395w–114(a)
42 USC 1395w–114(a)(3)(C)(i)

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Sec. 105

Requiring coverage under Medicare PDPs and MA–PD plans, without the imposition of cost sharing or utilization management requirements, of drugs intended to treat COVID–19 during certain emergencies

Cite42 USC 1395w–104(b)(3)

Cite42 USC 1395w–102

Cite42 USC 1395w–114(a)

Cite42 USC 1395w–114(a)(3)(C)(i)

Cites 4Cited by 0 across 0 sources